Drug and Alcohol Review

This study investigated involvement in substance use and sexual activities among adolescents in Cape Town, and specifically the associations between methampethamine use and sexual risk behaviours. Data were collected from 15 randomly selected and 15 matched schools in Cape Town via quantitative questionnaires. Students used hand‐held computers (PDAs) to answer the questions. A total of 4605 grade 9 students were sampled. Male and female students were almost equally likely to have used methamphetamine at least once (13% versus 12%). Students who had used methamphetamine in the past 30 days were significantly more likely to have had vaginal, anal or oral sex than students who had never used it, to have been pregnant/been responsible for a pregnancy and to have been diagnosed with a sexually transmitted infection. Logistic regression analysis indicated significant associations between methamphetamine use in the past 12 months and engaging in vaginal and anal sex. Drug abuse and sexually transmitted infections (STI) prevention services should incorporate the link between drugs and STI into their prevention and education strategies, especially those aimed at school‐going adolescents.

In this Harm Reduction Digest two observers and scholars of the 2001 Portuguese drug policy reform consider divergent accounts of the reform which viewed it as a ‘resounding success’ or a ‘disastrous failure’. Acknowledging from their own experience the inherent difficulties in studying drug law reform, Caitlin Hughes and Alex Stevens take the central competing claims of the protagonists and consider them against the available data. They remind us of the way all sides of the drug policy debates call upon and alternatively use or misuse ‘evidence’ to feed into discussions of the worth, efficacy and desirability of different illicit drug policies. In doing so they provide pause for thought for those of us who operate as drug policy researchers and drug policy advocates.

Simon Lenton

Co‐editor, Harm Reduction Digest

Introduction. This paper reviews epidemiological information about methamphetamine production and use in North America. Methods. Information is drawn from a range of sources, including, but not limited to, historical accounts, peer‐reviewed papers, population surveys and large national databases. Results. Methamphetamine and amphetamine use in North America is characterised by geographic variations, with different types of the drug, different routes of administration and different types of users at various times. Unlike some other drug use patterns in North America, the nature of methamphetamine use in Canada, Mexico and the United States has been linked closely in terms of production and supply of the drug. According to their national household surveys, the annual prevalence for ‘speed’ use in Canada was 0.8% in 2004, 0.3% for ‘anfetaminas’ and 0.1% for ‘metanfetaminas’ in Mexico in 2002, and 1.4% for ‘stimulants’ in the United States in 2006. Discussion. Although the data sources in the three North American countries are not consistent in methodology, terminology or frequency of reporting, all show similar trends. The type of stimulant most used has shifted from non‐medical use of pharmaceutical amphetamine to use of powder methamphetamine and then to use of ‘ice’. The indicators show the problem is greatest in the western parts of the countries and is moving eastward, but the decreased availability of pseudoephedrine may have a significant impact on the nature of the epidemic in the future. Nevertheless, use of methamphetamine poses a number of risks for users and specialised treatment resources for these various populations are needed.

Introduction and Aims. Alcohol is a key component of identity exploration for many young people, yet few studies have investigated identity construction in relation to problematic drinking. Increases in youth alcohol consumption have coincided with expanding use of communications technologies, particularly social networking sites (SNS), which have altered traditional conditions of identity construction. It has been found young people often engage with alcohol in the SNS environment by portraying themselves as binge drinkers. The current study applied an innovative approach to identity construction (the photographic essay) to provide insight into the portrayal of ‘alcohol‐identity’ on Facebook.

Design and Methods. One hundred and fifty‐eight university students completed a range of alcohol measures before providing access for researchers to view their Facebook profiles to operationalise their alcohol‐identity according to autophotographic methodology.

Results. Participants utilised a variety of photographic and textual material to present alcohol as a component of their identity on Facebook, with over half having selected an alcohol‐related profile image. Alcohol‐identity predicted alcohol consumption and problematic alcohol‐related behaviours as measured by questionnaires used to reliably identify alcohol‐related problems in university students. Almost 60% reported potentially problematic alcohol use according to the Alcohol Use Disorders Identification Test.

Discussion and Conclusions. Findings suggest that portraying oneself as a drinker is considered by many young people to be a socially desirable component of identity in the SNS environment, perpetuating an online culture that normalises binge drinking. Ready‐made Facebook photo essays provide an alternate method of accessing problematic alcohol use, supplementing self‐report measures.[Ridout B, Campbell A, Ellis L. ‘Off your Face(book)’: Alcohol in online social identity construction and its relation to problem drinking in university students. Drug Alcohol Rev 2012;31:20–26]

Stress‐ and drug‐related cues are major factors contributing to high rates of relapse in addictive disorders. Brain imaging studies have begun to identify neural correlates of stress and drug cue‐induced craving states. Findings indicate considerable overlap in neural circuits involved in processing stress and drug cues with activity in the corticostriatal limbic circuitry underlying both affective and reward processing. More recent efforts have begun to identify the relationships between neural activity during stress and drug cue exposure and drug relapse outcomes. Findings suggest medial prefrontal, anterior and posterior cingulate, striatal and posterior insula regions to be associated with relapse outcomes. Altered function in these brain regions is associated with stress‐induced and drug cue‐induced craving states and an increased susceptibility to relapse. Such alterations can serve as markers to identify relapse propensity and a more severe course of addiction. Efficacy of pharmacological and behavioral treatments that specifically target stress and cue‐induced craving and arousal responses may also be assessed via alterations in these brain correlates.